Provider Demographics
NPI:1790896983
Name:GAJEWSKI INC
Entity Type:Organization
Organization Name:GAJEWSKI INC
Other - Org Name:MCLEAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-766-3536
Mailing Address - Street 1:229 N THIRD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1610
Mailing Address - Country:US
Mailing Address - Phone:989-734-4701
Mailing Address - Fax:989-734-0991
Practice Address - Street 1:229 N THIRD ST
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1610
Practice Address - Country:US
Practice Address - Phone:989-734-4701
Practice Address - Fax:989-734-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010096413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6766OtherPROVIDER TRANSACTION ACCESS NUMBER
2336914OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MIMI6766OtherPROVIDER TRANSACTION ACCESS NUMBER